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1 0 STATE OF WYOMING LSO-0 SENATE FILE NO. SF00 Medicaid fraud recovery. Sponsored by: Senator(s) Peterson and Representative(s) Harvey A BILL for AN ACT relating to Medicaid; creating the Wyoming Medicaid False Claims Act; authorizing civil recoveries for the state as specified; prescribing duties of the attorney general; providing procedures; providing for a limitations period and applicability of the act; providing definitions; prescribing criminal penalties as specified for failure to maintain required records; creating a cause of action for retaliatory employment actions; and providing for an effective date. 0 Be It Enacted by the Legislature of the State of Wyoming: to read: Section. W.S. --0 through --0 are created ARTICLE SF00

2 0 STATE OF WYOMING LSO-0 FALSE MEDICAID CLAIMS --0. Short title. This act shall be known and may be cited as the "Wyoming Medicaid False Claims Act." --0. Definitions. 0 (a) As used in this act: (i) "Claim" means any request or demand under the Medicaid program, whether under a contract or otherwise, for money, property or services that: agent of the state; or (A) Is presented to an officer, employee or 0 (B) Is made to a contractor, grantee or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state: SF00

3 0 STATE OF WYOMING LSO-0 (I) Provides or has provided any portion of the money or property requested or demanded; or (II) Will reimburse the contractor, grantee or other recipient for any portion of the money or property which is requested or demanded. 0 (ii) "Knowing" and "knowingly" mean that a person, with respect to information, and with or without specific intent to defraud: (A) Has actual knowledge of the information; (B) Acts in deliberate ignorance of the truth or falsity of the information; or or falsity of the information. (C) Acts in reckless disregard of the truth 0 (iii) "Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property; SF00

4 0 STATE OF WYOMING LSO-0 (iv) "This act" means W.S. --0 through Acts subjecting person to treble damages; costs and civil penalties; exceptions. 0 (a) Any person who commits any of the following acts in relation to the Wyoming Medicaid program shall be liable to the state for three () times the amount of damages which the state sustains because of the act of that person. A person who commits any of the following acts shall also be liable to the state for the costs of a civil action brought to recover any of those penalties or damages, and shall be liable to the state for a civil penalty of not less than one thousand dollars ($,000.00) and not more than ten thousand dollars ($0,000.00) for each violation: (i) Knowingly presents or causes to be presented a false or fraudulent claim for payment or approval; 0 (ii) Knowingly makes, uses or causes to be made or used, a false record or statement material to a false or fraudulent claim; SF00

5 0 STATE OF WYOMING LSO-0 0 (iii) Is a beneficiary of an inadvertent submission of a false claim to any employee, officer or agent of the state or a political subdivision of the state, or to any contractor, grantee or other recipient of state funds or funds of any political subdivision of the state, who subsequently discovers the falsity of the claim and fails to disclose the false claim and make satisfactory arrangements for repayment to the state or affected political subdivision within fifteen () days after discovery of the false claim; (iv) Conspires to commit a violation of paragraph (i), (ii) or (iii) of this subsection. (b) An innocent mistake shall be a defense to an action under this act. (c) Notwithstanding subsection (a) of this section, 0 the court may assess not more than two () times the amount of damages which the state sustains because of the act in violation of subsection (a) of this section, and no civil penalty, if the court finds all of the following: SF00

6 0 STATE OF WYOMING LSO-0 (i) The person committing the violation furnished officials of the state who are responsible for investigating false claims violations with all information known to that person about the violation within thirty (0) days after the date on which the person first obtained the information; (ii) The person fully cooperated with any investigation by the state; 0 (iii) At the time the person furnished the state with information about the violation, no criminal prosecution, civil action or administrative action had commenced with respect to the violation and the person did not have actual knowledge of the existence of an investigation into the violation Attorney general investigations and prosecutions; powers of prosecuting authority; remedies for retaliation; venue; no private right of action. (a) The attorney general shall diligently investigate an alleged violation under W.S. --0(a). If the attorney general finds that a person has violated or is SF00

7 0 STATE OF WYOMING LSO-0 violating W.S. --0(a), the attorney general may bring a civil action under this section against that person. 0 0 (b) Any employee, contractor or agent shall be entitled to all relief necessary to make that employee, contractor or agent whole if that employee, contractor or agent is discharged, demoted, suspended, threatened, harassed or in any other manner retaliated against in the terms and conditions of employment because of lawful acts taken in good faith by the employee or others in furtherance of an action under this act, including investigation for, initiation of, testimony for or assistance in an action filed or investigated under this act. An action under this subsection shall not be brought more than three () years after the date when the retaliation occurred. A person may bring an action in the appropriate district court for the relief provided in this section. This section shall not otherwise be construed to create a private cause of action for violations of this act and is limited to the remedies expressly created by this section related to employment retaliation. (c) Any action under this act may be brought in the district court of any county in which the defendant, or any SF00

8 0 STATE OF WYOMING LSO-0 of them, resides or transacts business or in which any act prohibited by W.S. --0 occurred. (d) Except as provided in this act, nothing in this act shall be construed to create a private cause of action. (e) The remedies provided in this act are separate from and additional to any remedies available under the State Government Fraud Reduction Act Limitation of actions; retroactivity; burden of proof. (a) A civil action under W.S. --0(a) shall not 0 be brought more than six () years after the date on which the violation was committed or more than three () years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, whichever occurs last, provided that in no event shall a civil action be brought more than ten (0) years after the date on which the violation is committed. SF00

9 0 STATE OF WYOMING LSO-0 (b) In any action brought under W.S. --0, the state shall be required to prove all essential elements of the cause of action, including damages, by a preponderance of the evidence. 0 (c) Notwithstanding any other provision of law, a guilty verdict rendered in a criminal proceeding charging false statements or fraud, whether upon a verdict after trial or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential elements of the offense in any action which involves the same transaction as in the criminal proceeding and which is brought under W.S Remedies under other laws; liberality of construction; joint and several liability. 0 (a) The provisions of this act are not exclusive, and the remedies provided for in this act shall be in addition to any other remedies provided for in any other law or available under common law. (b) This act shall be liberally construed and applied to promote the public interest. SF00

10 0 STATE OF WYOMING LSO-0 (c) Liability pursuant to this act is joint and several for any violation done by two () or more persons. Section. W.S. --0(a) by creating new paragraphs (xii) and (xiii) and -- by creating a new subsection (e) are amended to read: --0. Definitions. 0 (a) As used in this chapter: (xii) "Intentional" means that a person, with respect to information, intended to act in violation of the law; (xiii) "Knowing" or "knowingly" includes intentional or intentionally and means that a person, with respect to information, acts: 0 (A) With actual knowledge of the information; 0 SF00

11 0 STATE OF WYOMING LSO-0 falsity of the information; or (B) In deliberate ignorance of the truth or (C) In reckless disregard of the truth or falsity of the information. --. Providing or obtaining assistance by misrepresentation; penalties. 0 (e) A person who fails to maintain records in accordance with Medicaid program rules and requirements for medical assistance is guilty of: (i) A felony punishable by imprisonment for not more than ten (0) years, a fine of not more than ten thousand dollars ($0,000.00), or both, if the value of related medical assistance is five hundred dollars ($00.00) or more; 0 (ii) A misdemeanor punishable by imprisonment for not more than six () months, a fine of not more than seven hundred fifty dollars ($0.00), or both, if the value of related medical assistance is less than five hundred dollars ($00.00). SF00

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